Exchange Navigator and Assister Plans Take Shape

With open enrollment less than six months away, state-based and state partnership exchanges are gearing up to hire the people who will assist consumers as they enroll in coverage through the exchange. All exchanges must establish a navigator program; in-person assister (IPA) programs are optional for state-based exchanges, are not required for federally facilitated exchanges, and are required for state partnership exchanges performing consumer assistance functions. Although both the navigator and IPA programs have a number of requirements they must adhere to, states establishing these programs have a lot of flexibility related to the structure. For a quick snapshot of how navigator and IPA requirements differ among state-based, state partnership, and federally facilitated exchanges, take a look at this fact sheet from Enroll America.
We’ve examined the applications and RFPs from Colorado, Delaware, Maryland, New York andNevada to see how each state is approaching building their navigator  and in-person assistance programs. Below we highlight what each state is doing across a few key areas.
Contract model
Some states are directly procuring the services of individuals and groups that will act as navigators and assisters. Others are hiring an entity to oversee the navigator and in-person assistance programs and to hire the individuals and organizations. States can also take a hybrid approach and use aspects of both models.

• Maryland and Delaware are soliciting entities that will hire and oversee organizations that serve as assisters and navigators. Maryland seeks “Regional Connector Entities” and Delaware is procuring a “Marketplace Assister entity.”
• Colorado is seeking applications for “Assistance Sites”, which are organizations “trusted in their community and located conveniently,” as well as “Regional Hubs”, organizations that receive enhanced awards to take on additional responsibilities for supporting training, outreach, information sharing, and collaboration. Both entities will employ Health Coverage Guides, who will perform outreach, conduct public education, and provide application support for people looking for coverage through the exchange.
• Nevada and New York are procuring the organizations and individuals that will serve directly as their navigators and assisters. New York will also make awards to lead contractors with subcontracting organizations.

Performance metrics
States are building in metrics to measure navigators’ and assisters’ performance and to ensure that grant money is used to maximize outcomes related to outreach and enrollment.

• Colorado will evaluate grantees in part by measuring outreach, service and enrollment outcomes, receipt and maintenance of certification, and customer satisfaction.
• Nevada will use data to evaluate navigators and IPAs, and the exchange provides examples of metrics it may use, including:
  • number and percentage of consumers or small businesses enrolled in coverage;
  • number and percentage of consumers reached who sign up to receive updates through the exchange’s Facebook page or Twitter account, consumer or small business satisfaction surveys; and
  • “mystery shoppers” that rate the grantee’s ability to provide correct information to consumers.
• Maryland will require Connector Entities to report performance metrics on a quarterly basis. Metrics collected include impact of entities on enrollment into insurance products, level of effort required to enroll individuals into products, performance related to vulnerable and/or hard-to-reach populations, “steering” individuals to enroll into plans for reasons other than their best interests, and consumer satisfaction.
• New York’s application also requires applications by navigator and IPAs to include a plan for monitoring the number of enrollee applications facilitated by IPA and navigator staff. This should include a plan for correcting non- and under-performance. The state will require the contractor to develop subcontracts that include provisions to enforce improved productivity, and the application states that IPA and navigator contractors will not be compensated for substandard performance.
• Delaware’s RFP stipulates that the Marketplace Assister Entity may be required to provide performance reports on individual assisters as necessary. Performance metrics will be part of the review for assister recertification, but are not specified in the RFP.

Certification
All navigators and IPAs are required to complete training, but specific certification standards and oversight structures are left to states.

• Nevada will require navigators and enrollment assisters who enroll individuals in QHPs but do not have a producer license to pass a certification test to ensure they adequately completed training and receive Exchange Enrollment Facilitator certification from the Department of Insurance.
• Maryland will certify navigators once they successfully complete required training, which involves 120 hours over the course of a three-week program. Individual exchange navigators will be certified by the exchange; SHOP navigators will be certified by the insurance department. Assisters will not be certified.
• Colorado’s Health Coverage Guides must complete training and receive assignment from a Certified Assistance Site in order to receive certification. Assignment includes completion of a background check and signing conflict of interest disclosures.
• Delaware’s Marketplace Assisters must successfully complete training, provide three letters of reference from the community and attest to a number of requirements related to conflict of interest and ethics.
• New York requires that contractors ensure all applicable staff are certified before providing any services to consumers, but does not identify specific certification requirements.

What decisions has your state made related to the navigator and IPA programs? Has your state put out an RFP for its navigator or in-person assister program? Tell us in the comments below.